Chemotherapy for advanced bowel cancer
This page tells you about chemotherapy for bowel cancer that has come back, or has spread when it is diagnosed. You can find the following information
Chemotherapy for advanced bowel cancer
Chemotherapy for advanced bowel cancer is unlikely to cure your cancer. But it may shrink the tumour and help you live longer. Other aims of treatment are to slow the growth of the cancer and control symptoms such as pain, loss of appetite and weight loss.
You may have treatment as tablets to take at home. Or you may have treatment as liquids into a vein. Your doctor will take into account various factors when deciding which chemotherapy treatment is best for you. They will look at which treatments you have already had and how long it took for the cancer to come back. Your doctor will discuss the treatment options with you.
Sometimes doctors use surgery to remove bowel cancer cells that have spread to the liver. You may have chemotherapy to shrink the cancer before the operation. You are also likely to have chemotherapy after surgery.
You can view and print the quick guides for all the pages in the treating bowel cancer section.
Treatment with chemotherapy is unlikely to cure advanced bowel cancer. But it may shrink the cancer and help you to live longer. Other aims of treatment are to slow the growth of the cancer and control symptoms such as pain, loss of appetite and weight loss.
For advanced cancer, the aim of chemotherapy is to help you feel better. So if you find the side effects too much, you can stop the treatment whenever you want to.
The chemotherapy drugs doctors use for bowel cancer that has come back after treatment or has spread are
- Capecitabine (Xeloda) tablets
- Fluorouracil (5FU) into a vein
- Raltitrexed into a vein. You may have this drug if you cannot have 5FU or capecitabine
- Oxaliplatin into a vein
- Irinotecan into a vein
Doctors can use a number of different combinations of these drugs, including
- FOLFOX – a combination of folinic acid (leucovorin), fluorouracil and oxaliplatin
- FOLFIRI – a combination of folinic acid (leucovorin or calcium folinate), fluorouracil and irinotecan
- XELOX - oxaliplatin and capecitabine
The links above take you to detailed information about these treatments and their side effects. There is also detailed information about the side effects of bowel cancer chemotherapy in this section.
You may have treatment as tablets to take at home. Or you may have treatment as liquids given into a vein. Your doctor will take into account various factors when deciding which chemotherapy treatment is best for you. They will look at which treatments you have already had and how long it took for the cancer to come back. Your doctor will discuss the treatment options with you.
Treatment given when the cancer first comes back is called first line treatment. If the cancer comes back after first line treatment, or if the first line treatment does not control the cancer, you may be able to have a different chemotherapy treatment. This is called second line treatment.
Trials are continually being carried out to try and improve treatment for advanced bowel cancer. Trials may use new drugs or try different combinations of drugs. You can find information about chemotherapy trials for bowel cancer on our clinical trials database.
If you have treatment into a vein, you usually have it in the outpatient department or chemotherapy day unit. You can have the chemotherapy through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the chemotherapy directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.
If you have treatment with capecitabine tablets, you will be able to take them at home. You usually take capecitabine tablets twice a day for a few months. You take the treatment daily for a few weeks and then have a break, before starting treatment again.
Some people prefer to have treatment with tablets because they can take them at home. Then you don't have to go to hospital so often. Capecitabine is a type of fluorouracil. But it causes different side effects to fluorouracil given into a vein. The tablets are less likely to cause diarrhoea or a sore mouth. But they are more likely to cause sore, red skin on your palms and soles, which may peel. This is known as hand and foot syndrome (palmar-plantar syndrome).
Your doctor will usually arrange a scan before you start treatment and again about 3 months later. Your doctor can measure the tumour on the scan and so will be able to see how well the treatment is working. The tumour may have
- Got smaller
- Stayed the same
- Got bigger
If the cancer has stayed the same size, your doctor will want to talk to you about whether or not it is worth carrying on with the treatment.
If it has got smaller or remained the same, you may have treatment for another 4 to 6 months. At this point, you may continue with treatment, as long as you are not having too many side effects. Or you may have a break from treatment before starting again. Your doctor will talk through the pros and cons of the different treatment options with you. You normally have a CT scan every 2 to 3 months to check the treatment is still working.
If the cancer has got bigger, your doctor will stop the chemotherapy and may suggest trying a different treatment.
Sometimes, doctors use surgery to remove bowel cancer cells that have spread to the liver (liver metastases). You can normally only have this treatment if there is no sign that the cancer has spread anywhere else in the body, apart from the liver. You will usually have a PET-CT scan to check whether there are cancer cells outside the liver.
If the liver tumour is too large to operate on, you may have chemotherapy to try to shrink the cancer and make it easier to remove. You often have chemotherapy both before and after surgery.
If your doctor believes that standard chemotherapy for advanced bowel cancer is unlikely to help you, they may offer you treatment as part of a clinical trial. Trials test new, experimental drugs being developed as well as testing different combinations of drugs already available.
If you are offered experimental treatment
- You should always be offered it as a part of a clinical trial
- All the risks and possible benefits should be clearly explained to you, and you should have the time to read through and understand the patient information sheet
- Previous research will have suggested that the drug will help bowel cancer
- The trial will help doctors find out how much it is likely to help people in the future
- Your doctors will find out more about the side effects of the drug from the trial results
You can leave a trial at any time. You do not have to give a reason.
For information about having chemotherapy, look at our main chemotherapy section. It explains the treatment in more detail including
- What chemotherapy involves
- How chemotherapy is planned
- How you have the treatment
- General chemotherapy side effects
- Side effects of specific drugs
- Living with chemotherapy
Our bowel cancer organisations page has details of information services you can contact for more information about bowel cancer and its treatment. There are also books and booklets available, some of which are free.
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